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Haemodynamic monitoring during noncardiac surgery: past, present, and future
AbstractDuring surgery, various haemodynamic variables are monitored and optimised to maintain organ perfusion pressure and oxygen delivery – and to eventually improve outcomes. Important haemodynamic variables that provide an understanding of most pathophysiologic haemodynamic conditions during surgery include heart rate, arterial pressure, central venous pressure, pulse pressure variation/stroke volume variation, stroke volume, and cardiac output. A basic physiologic and pathophysiologic understanding of these haemodynamic variables and the corresponding monitoring methods is essential. We therefore revisit the pathoph...
Source: Journal of Clinical Monitoring and Computing - April 30, 2024 Category: Information Technology Source Type: research

Agreement between three noninvasive temperature monitoring devices during spinal anaesthesia for caesarean delivery: a prospective observational study
This study aimed to compare a noninvasive core temperature monitor with two readily available peripheral temperature monitors during obstetric spinal anaesthesia. We undertook a prospective observational study including elective and emergency caesarean deliveries, to determine the agreement between affordable reusable surface temperature monitors (Welch Allyn SureTemp ® Plus oral thermometer and the Braun 3-in-1 No Touch infrared thermometer) and the Dräger T-core© (using dual-sensor heat flux technology), in detecting thermoregulatory changes during obstetric spinal anaesthesia. Predetermined clinically relevant limits...
Source: Journal of Clinical Monitoring and Computing - April 30, 2024 Category: Information Technology Source Type: research

Alternative sensor montage for Index based EEG monitoring. A systematic review
AbstractThe main objective of this systematic review is to assess the reliability of alternative positions of processed electroencephalogram sensors for depth of anesthesia monitoring and its applicability in clinical practice. A systematic search was conducted in PubMed, Embase, Cochrane Library, Clinical trial.gov in accordance with reporting guidelines of PRISMA statement together with the following sources: Google and Google Scholar. We considered eligible prospective studies, written in the English language. The last search was run on the August 2023. Risk of bias and quality assessment were performed. Data extraction...
Source: Journal of Clinical Monitoring and Computing - April 27, 2024 Category: Information Technology Source Type: research

Comparison of automated and manual control methods in minimal flow anesthesia
ConclusionThe ACA mode was more advantageous than the MCA mode, reaching target AA concentrations faster and requiring fewer adjustments to achieve a constant depth of anesthesia. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - April 25, 2024 Category: Information Technology Source Type: research

Can the values of the venous-to-arterial pCO2 difference (pCO2 gap) be negative? A response.
(Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - April 22, 2024 Category: Information Technology Source Type: research

A machine learning algorithm for detecting abnormal patterns in continuous capnography and pulse oximetry monitoring
This study pres ents a promising advancement in respiratory monitoring, focusing on reducing false alarms and enhancing accuracy of alarm systems. Our algorithm reliably distinguishes normal from abnormal waveforms. More research is needed to define patterns to distinguish abnormal ventilation from artifacts. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - April 15, 2024 Category: Information Technology Source Type: research

Effect of vertical stopcock position on start-up fluid delivery in syringe pumps used for microinfusions
AbstractThe purpose of this in vitro study was to evaluate the impact of the vertical level of the stopcock connecting the infusion line to the central venous catheter on start-up fluid delivery in microinfusions.  Start-up fluid delivery was measured under standardized conditions with the syringe outlet and liquid flow sensors positioned at heart level (0 cm) and exposed to a simulated CVP of 10 mmHg at a set flow rate of 1 ml/h. Flow and intraluminal pressures were measured with the infusion line connec ted to the stopcock primarily placed at vertical levels of 0 cm, + 30 cm and − 30 cm or primarily plac...
Source: Journal of Clinical Monitoring and Computing - April 15, 2024 Category: Information Technology Source Type: research

Is EIT-guided positive end-expiratory pressure titration for optimizing PEEP in ARDS the white elephant in the room? A systematic review with meta-analysis and trial sequential analysis
AbstractElectrical Impedance Tomography (EIT) is a novel real-time lung imaging technology for personalized ventilation adjustments, indicating promising results in animals and humans. The present study aimed to assess its clinical utility for improved ventilation and oxygenation compared to traditional protocols. Comprehensive electronic database screening was done until 30th November, 2023. Randomized controlled trials,  controlled clinical trials, comparative cohort studies, and assessments of EIT-guided PEEP titration and conventional methods in adult ARDS patients regarding outcome, ventilatory parameters, and P/F ra...
Source: Journal of Clinical Monitoring and Computing - April 15, 2024 Category: Information Technology Source Type: research

Knowledge-based, computerized, patient clinical decision support system for perioperative pain, nausea and constipation management: a clinical feasibility study
We report the development and feasibility validation of a knowledge-based CDSS aiming at optimizing the management of perioperative pain, postoperative nausea and vomiting (PONV), and laxative medications. This novel CDSS uses patient adaptive testing through a smartphone display, literature-based rules, and individual medical prescriptions to produce direct medical advice for the patient user. Our objective was to test the feasibility of the clinical use of our CDSS in the perioperative setting. This was a prospective single arm, single center, cohort study conducted in Strasbourg University Hospital. The primary outcome ...
Source: Journal of Clinical Monitoring and Computing - April 12, 2024 Category: Information Technology Source Type: research

The predictive role of carotid artery flow time for anesthesia-induced hypotension in high-risk elderly patients
AbstractHypotension induced by general anesthesia is associated with postoperative complications, increased mortality, and morbidity, particularly elderly patients. The aim of this study was to investigate the effectiveness of corrected carotid artery flow time (FTc) for predicting hypotension following anesthesia induction in patients over 65 years old.  After faculty ethical committee approval and written informed consent, 138 patients (65 years and older, ASA physical status I–III) who scheduled for elective surgery were included in this study. In the pre-operative anesthesia unit, the carotid artery FTc value was me...
Source: Journal of Clinical Monitoring and Computing - April 12, 2024 Category: Information Technology Source Type: research

Algor-ethics: charting the ethical path for AI in critical care
AbstractThe integration of Clinical Decision Support Systems (CDSS) based on artificial intelligence (AI) in healthcare is groundbreaking evolution with enormous potential, but its development and ethical implementation, presents unique challenges, particularly in critical care, where physicians often deal with life-threating conditions requiring rapid actions and patients unable to participate in the decisional process. Moreover, development of AI-based CDSS is complex and should address different sources of bias, including data acquisition, health disparities, domain shifts during clinical use, and cognitive biases in de...
Source: Journal of Clinical Monitoring and Computing - April 4, 2024 Category: Information Technology Source Type: research

The time constant of the cerebral arterial bed: exploring age-related implications
This study assessed differences in τ among healthy volunteers across different age groups. Simultaneous r ecordings of transcranial Doppler cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP) were performed on two groups: young volunteers (below 30 years of age), and older volunteers (above 40 years of age). τ was estimated using mathematical transformation of ABP and CBFV pulse wav eforms. 77 healthy volunteers [52 in the young group, and 25 in the old group] were included. Pulse amplitude of ABP was higher [16.7 (14.6–19.4) mmHg] in older volunteers as compared to younger ones [12.5 (10.9–14.4)...
Source: Journal of Clinical Monitoring and Computing - April 4, 2024 Category: Information Technology Source Type: research

Machine learning based analysis and detection of trend outliers for electromyographic neuromuscular monitoring
ConclusionsEngineered TOF-R trend features and the resulting Cost-Sensitive Logistic Regression (CSLR) models provide useful insights and serve as a potential first step towards the automated removal of outliers for neuromuscular monitoring devices.Trial registrationNCT04518761 (clinicaltrials.gov), registered on 19 August 2020. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - April 4, 2024 Category: Information Technology Source Type: research

Towards the automatic detection and correction of abnormal arterial pressure waveforms
AbstractBoth over and underdamping of the arterial pressure waveform are frequent during continuous invasive radial pressure monitoring. They may influence systolic blood pressure measurements and the accuracy of cardiac output monitoring with pulse wave analysis techniques. It is therefore recommended to regularly perform fast flush tests to unmask abnormal damping. Smart algorithms have recently been developed for the automatic detection of abnormal damping. In case of overdamping, air bubbles, kinking, and partial obstruction of the arterial catheter should be suspected and eliminated. In the case of underdamping, reson...
Source: Journal of Clinical Monitoring and Computing - April 4, 2024 Category: Information Technology Source Type: research

Continuity with caveats in anesthesia: state and response entropy of the EEG
AbstractThe growing use of neuromonitoring in general anesthesia provides detailed insights into the effects of anesthetics on the brain. Our study focuses on the processed EEG indices State Entropy (SE), Response Entropy (RE), and Burst Suppression Ratio (BSR) of the GE EntropyTM Module, which serve as surrogate measures for estimating the level of anesthesia. While retrospectively analyzing SE and RE index values from patient records, we encountered a technical anomaly with a conspicuous distribution of index values. In this single-center, retrospective study, we analyzed processed intraoperative electroencephalographic ...
Source: Journal of Clinical Monitoring and Computing - April 3, 2024 Category: Information Technology Source Type: research